I want to thank Drs. Walley and Gigli for their work organizing this conference and for the privilege of presenting my personal observations to this distinguished audience. I also want to bring you greetings from Mary Mother of the Church Abbey, a Benedictine community in Richmond, Virginia where my wife and I are oblates. For the past five years I have had the responsibility of being Chairman of the Department of Obstetrics at the Medical College of Virginia, Virginia Commonwealth University in Richmond, Virginia. I have been Residency Program Director of Obstetrics and Gynecology at MCV and prior to this position, I was Residency Program Director of Obstetrics and Gynecology at the University of Arizona in Tucson, Arizona. Prior to that I was Fellowship Program Director of Maternal and Fetal Medicine at the University of North Carolina in Chapel Hill, North Carolina. All of these universities are publicly funded secular institutions. The comments that follow arise from my observations over the past twenty years in these various positions and my associations with residents in training.

I believe that each conception from the first day is a unique human creation of God. I believe that it is rarely, if ever, acceptable to kill a human creation. However, in 1973 the United States Supreme Court ruled that a woman's right to privacy superseded the state's interest in protecting life.1 Abortion in the U.S. flourished after 1973 but has diminished slightly since its peak in 1990.2 Abortion providers have also diminished. However, there are approximately 1.3 million abortions annually in the U.S. or about one in four pregnancies. Training in abortion techniques is mandated for all Ob/Gyn residents unless they claim moral or religious objection.

Medical specialty training in the U.S. is regulated by the Accreditation Council for Graduate Medical Education (ACGME). Each specialty is monitored and regulated by the Residency Review Committee(RRC) for that specialty. The RRC for Ob/Gyn publishes annual Program Requirements that specify virtually every aspect of the training experience.3 After training, specialty certification is conferred by the American Board of Medical Specialties and for Ob/Gyn it is the American Board of Obstetrics and Gynecology. In 1995 the Ob/Gyn RRC proposed Program Requirements that included a mandate for training in abortion. Only legislation passed by the U.S. Congress resulted in revision of these requirements to allow any resident and any program with ethical or moral objection to choose to decline such training.4 It remains the case, however, that any resident or program without such objection is required to participate in abortion training and every program regardless of their position on abortion must provide access to abortion training for any resident who requests the training.

There are 254 accredited Ob/Gyn residencies in the U.S. with 4700 total training positions. Of these, approximately 17 or 7% are Church affiliated with 236 or 5% of the total number of residents in training. It may be estimated, however, that of the 4426 residents in non Church affiliated programs, as many as 1151 are at least nominally Catholic and that a similar number of faculty may be at least nominally Catholic. Therefore, by far the larger pool of Catholic Ob/Gyn resident trainees are found in secular programs that are by RRC regulation obligated to provide abortion training unless the resident objects on moral or religious grounds. A survey conducted in 1998 by the National Abortion Federation with 179 of 269 programs responding showed that 46% of the programs included routine first trimester abortion training, 34% offered it as an elective, and 44% offered routine second trimester abortion training.5

The potential obstacles to a resident's right to be trained according to conscience, a right that is now supported by law and by RRC regulation, are many. Overt or covert selection bias of faculty or residents is well known among my own residents and faculty. A candidate's position on abortion is often explored either directly or indirectly during the interview process, and the program's position and emphasis is typically made very clear if abortion is a significant element of the experience. The first question asked of me as a candidate for the Chair of my department was how I could serve as a pro life chair of a secular department. Program pressure is often subtle and sometimes obvious and takes the form of describing abortion as a public service that any caring and compassionate provider would want to learn and provide or the form of work equality. If the individual does not participate in abortion, such a choice would result in the overwork the others in the program. Residents or faculty with a pro life position are often marginalized as "pro life zealots" and dialogue is discouraged.

What can be done? Teaching the truth is a strong response to the abortion movement. Ethics, the modern secular religion, can even be a powerful tool in this effort. Autonomy is at the heart of any discussion of medical ethics, but we must emphasize the balance of physician and patient autonomy. Informed consent is a formal effort to protect autonomy, but in the practice of abortion, informed consent is often superficial and dysfunctional. Truly informed consent requires an unbiased analysis of the benefits and risks of abortion including short and long term. A discussion of the physical and emotional consequences of abortion is rarely if ever heard in abortion clinics. Discussions are almost never conducted of damage to reproductive organs, loss of the ability to have and increased suicide rates among women choosing abortion. Abortion clinics are not known for their efforts to explore a patient's core beliefs in God or in the humanity of her unborn child, and yet such a discussion is clearly a critical part of a truly informed consent discussion. In an academic environment, even a secular academic environment, we can discuss ethics. We can discuss autonomy and beneficence. We can discuss the true limits of science and the real consequences of abortion. We can discuss the law and the physician's legal obligations and rights. A truly open and scholarly discussion of these issues quickly shows the intellectual dishonesty of the abortion movement and their clear disregard for the complete welfare of the patient.

While those of us here present willingly submit to the direction and guidance of the Holy Father and our Father in Heaven, we are discouraged from discussions of our faith in our secular public offices. We can, however, discuss ethics and the law. We can, as mentioned above, discuss issues of autonomy and beneficence. We can explore the hierarchy of values that any ethical discussion must establish for the resolution of ethical conflicts and God may be mentioned as one such over riding value upon which ethical conflicts may be resolved. The hierarchy of values upon which the decision to abort a pregnancy is based must be established if the physician is to address completely the patient's total welfare. Abortion is legal under U.S. law. Law is based in civil authority and instituted by society to bring order to public behavior. Law almost always has either ethical or religious origins. What is obvious in any examination of the arguments of the abortion movement is the selective ethics of their position. They focus only on the woman's right to abort. The abortion movement typically minimizes the patient's right to a fair and complete discussion of the short and long term consequences of abortion. They avoid a full discussion of alternatives including adoption and her right to know about the development and nature of her unborn child. The patient's right to be free of coercion in her decision and her right to examine her personal deeply held beliefs about life are rarely honored. The abortion movement denies any rights to the unborn child as they ignore the rights of the physician.

Science tells us that each conception is a genetically unique human creation. There is no day in the life of an unborn child that marks a definitive change from the day before and we have no means of knowing with life or death precision exactly how far any individual pregnancy has progressed. Bio-ethics tells us that autonomy and beneficence are the controlling standards of ethical choices. We may, however, choose the ultimate standard by which ethical conflicts are to be resolved: i.e. God, money, status, power, etc. Bio-ethics tells us that the patient must be free of ignorance and coercion in her decision. Bio ethics tells us that physicians have the right to decline to participate in treatments they deem objectionable on moral or ethical grounds. The law tells us women have the right to abort their unborn but that physicians have the right to decline and that training programs and residents have the right to decline. However, in practice enormous pressure is applied to programs and residents by an abortion movement that is corrupt in its selective and self serving promotion of a profitable medical procedure.

What can be done by the Church? Clearly, strengthen church affiliated programs. Make these programs the best of the best. Invest in them and make these training programs the desired programs in the country. The Church must support those Catholics found in secular programs by speaking out unambiguously from the parish pulpit in support of life. The Church can provide spiritual, emotional, and even legal support for those subjected to illegal discrimination or coercion based on their religious position on abortion. The Church might support such programs as a web site for pro life trainees, and the Church could support a national speaker program for the support of the pro life Ob/Gyn training programs.

There are pro life medical professional societies in the U.S. that are trying to provide some of these sorts of supportive efforts. The American Association of Pro-Life Obstetricians and Gynecologists is a fully organized special interest group within the American College of Obstetricians and Gynecologists. AAPLOG represents about 2500 fellows of the American College's total membership of about 30,000. The AAPLOG web-site is aaplog.org. AAPLOG sponsors meetings and publishes public statements that may contradict ACOG positions on abortion issues. Another pro life professional organization is the Pro-Life Maternal-Fetal Medicine group within the Society of Maternal and Fetal Medicine. Their web site is prolifemfm.org.

I do not presume to be able to teach this group anything about ethics or abortion. I am privileged to have the opportunity to share my experiences with you and to spend my time listening and learning. Thank you Drs. Walley and Gigli, and everyone here for this opportunity.

1. 410 U.S. 113 Supreme Court of the United States. Roe, et al. v. Wade, District Attorney of Dallas County, January 22, 1973. Appeal from the United States District Court for the Northern District of Texas. No. 70-18.

2. Abortion Surveillance: Preliminary analysis-United States, 1996. MMWR Dec 4, 1998/47(47);1025-1028, 1035. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055812.htm

3. Accreditation Council for Graduate Medical Education. Program Requirements for Residency Education in Obstetrics and Gynecology. http://www.acgme.org/req/220pr999.asp

4. Omnibus Appropriations/Abortion&Medical Licensing-Accreditation. Senate Bill SS2280. http://www.senate.gov/^rpc/rva/1042/104239.htm

5. National Abortion Federation. Family Planning Perspective Nov/Dec 2000. Available at : http://www.prochoice.org/

Address Correspondence to:
John W. Seeds, MD, Professor and Chairman, Department of Obstetrics and Gynecology,
Virginia Commonwealth University, MCV Campus, PO Box 980034, Richmond, Virginia 23298-0034, USA
(Tel: 804-828-7877; Fax: 804-754-0845; <seeds746@cs.com>)